pica and Depressive-Disorder

"Pica" is the term used to describe craving for non-food and nonnutritive items like dirt, chalk, or paper. Pagophagia (compulsive ice chewing) is a particular form of pica that is characterized by ingestion of ice, freezer frost, or iced drinks. It is usually associated with iron deficiency anemia or mental abnormalities like intellectual disabilities, autism, etc. Very few case reports have reported association of eating ice cubes with compulsive behavior or depressive disorders. In this case report, we present the association of pagophagia with sadness in a patient with recurrent depressive disorder. A 44-year-old female suffering from depressive disorder since the age of 33 years presented with symptoms of an intense desire to eat ice cubes that she was unable to resist and would feel better only after consumption of ice cubes or iced drinks. Initially she would consume about 250-500 g of ice cubes per day, but gradually the quantity of consumption of ice increased to about 10-12 kg of ice cubes per day. These symptoms were related to low mood and stress. The preoccupation with consumption of ice was associated with significant psychosocial dysfunction and interpersona problems with the spouse. She was managed with venlafaxine 187.5 mg/day and cognitive behavior psychotherapy (identifying her cognitive errors, generating alternative thoughts, problem solving, activity scheduling and mastery, and pleasure technique) with which her depressive symptoms improved and her pagophagia reduced significantly but did not subside completely. She learned to use alternative coping mechanisms to deal with her psychosocial stressors.

Topics: Adult; Depressive Disorder; Diagnosis, Differential; Female; Humans; Ice; Pica; Recurrence

Trichobezoar is a rare condition that occurs mostly in young women with psychiatric disorders such as trichotillomania and trichophagia. We report the case of a giant gastric trichobezoar in a 21-year-old woman who presented with chronic abdominal pain, vomiting and weight loss. Abdominal examination revealed a large epigastric mass. Endoscopic and imaging findings were highly suggestive of a gastric trichobezoar. Surgical extraction of the huge hair mass was successfully performed through an open gastrotomy. Postoperatively, history of a neglected chronic depression with suicidal ideation was diagnosed. Consequently, the patient was referred to the psychiatric department for mental healthcare, to prevent trichobezoar recurrences.

Topics: Bezoars; Depressive Disorder; Female; Gastroscopy; Humans; Laparotomy; Pica; Stomach; Tomography, X-Ray Computed; Trichotillomania; Young Adult

Topics: Abdominal Pain; Adult; Anemia, Iron-Deficiency; Depressive Disorder; Diagnosis, Differential; Female; Hemoglobins; Humans; Lead; Lead Poisoning; Menorrhagia; Pica; Vomiting

A 20-year-old woman was brought to the surgical outpatient department with the strange history of irresistible desire to ingest metallic substances, mainly nails and pins. Her problems were initiated after she was forced to marry against her wish. She had no abdominal complaints and on examination the abdomen appeared absolutely normal. Plain radiograph confirmed numerous nails and pins inside her GI tract. On detailed psychologic evaluation, she was found to be suffering from deviant sexual behavior and marriage against her wish acted as a stressor in the development of this habit.

Topics: Adult; Depressive Disorder; Family Conflict; Female; Humans; Iran; Metals; Pica; Radiography, Abdominal; Young Adult

Transdermal fentanyl is an opioid analgesic that is effective on chronic pain, and which appears to be advantageous due to several factors such as ease of administration, the relatively stable serum concentration and long dose intervals. Nevertheless, the danger of abuse and dependence exists among patients who are prescribed fentanyl patches. We present a case of transdermal fentanyl abuse, where the administration route of the drug was changed. Our patient, who had no history of substance abuse and who suffered from chronic nonmalignant pain, used the fentanyl transdermal patches as oral transmucosal medication, raising the dose by ten-fold. This abuse of the drug was only for analgesic purposes without seeking anxiolysis and/or euphoria. After treatment and progressive reduction of fentanyl, the patient remains in good condition, and is currently taking the initial dose of the drug transdermally, without having experienced any withdrawal symptoms.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Chronic Disease; Depressive Disorder; Drug Administration Schedule; Drug Therapy, Combination; Dysthymic Disorder; Female; Fentanyl; Fluoxetine; Greece; Humans; Mouth Mucosa; Pain; Pica; Polychondritis, Relapsing; Self Administration; Substance-Related Disorders

The case of a person with severe mental handicap whose pica became uncontrollable during episodes of depressive illness is described. Treatment of the depression with lofepramine markedly reduced the pica, and withdrawal of lofepramine led to recurrence. It is suggested that biological symptoms of depression should be monitored in people with severe mental handicap who show significant episodic worsening of long-standing repetitive behaviour.

Topics: Depressive Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Foreign Bodies; Humans; Intellectual Disability; Intestines; Lofepramine; Male; Middle Aged; Pica; Recurrence; Self-Injurious Behavior; Social Behavior